HL7



Attendees:

|Name |E-mail Address |Sessions Attended |

|Nancy LeRoy |nancy.leroy@med. |Tues: Q1-Q4; Wed: Q1-Q4 |

|John Travis |jtravis@ |Tues: Q1-Q4; Wed: Q1-Q4 |

|Matthew Greene |matthewgreene2@med. |Tues: Q1-Q4; Wed: Q1-Q4 |

|Bob Dolin |Robert.H.Dolin@ |Tues: Q1 |

|Tod Ryal |tryal@ |Tues: Q1, Q3: Wed: Q1, Q2, Q4 |

|Jari Porrasmaa |Jari.porrasmaa@uku.fi |Tues: Q1 |

|Harry Rhodes |Harry.Rhodes@ |Tues: Q1-Q2 |

|Michelle Dougherty |Michelle.Dougherty@ |Tues: Q4 |

|Calvin Beebe |cbeebe@mayo.edu |Tues: Q1 |

|Mike Kenig |mkenig@ |Tues: Q1 |

|Peter Haug |Peter.haug@j |Tues: Q1 |

|Keith W. Boone |Keith.boone@ |Tues: Q1 |

|Bill Braithwaite |Bill.Braithwaite@ |Tues: Q1 |

|Garry Cruickshank |g.cruickshank@sympatico.ca |Wed: Q4 |

Highlights from meeting:

Tuesday, September 13, 2005

▪ Decision was made to move from DSTU to normative ballot.

▪ Preliminary work on Query by parameter began.

▪ V2.6 ballot reconciliation was completed.

▪ V3 query message use case began.

Wednesday, September 14, 2005

▪ Begin to review and update consent section in V2.X

▪ Met with Garry Cruickshank from the Canada Health Infoway Canadian Electronic Drug Messaging (CeRx) project regarding their need for consent messages in V3.

Tuesday, September 13, 2005

Quarter 1 - Joint meeting with Structured Documents.

The meeting was opened with Bob Dolin asking the question, is there enough interest to go to normative ballot? Do we want to have a V3 MR message?

There seems to be interest in query process at least from the international community.

Jari Porrasmaa shared that Finland – will be looking for this in the future. He mentioned that the UK has already done some messaging in this arena. It’s a metadata registry for document retrieval, patient demographics.

John Travis shared that Cerner has a vested interest in going forward since they will be working with the UK. He also mentioned that France and Australia also have an interest in this.

The observation was made that we would need to have active input from those who have an interest in the development of the query process.

Keith Boone gave the group a brief update regarding XDS which is a cross enterprise-sharing system. EB XML - Is intended for use in RHIOs or other organizations with facilities in disparate locations to share documents. Keith sees this DSTU as a potential interface to the XDS project.

Bob Dolin did a review of the DSTU for the committee. The storyboard is not normative although the interactions are. Two messages have been defined. The meat of the V3 MR/IM DSTU is:

Section 2. Document Type

▪ 2.1 Storyboards (currently are 2)

▪ 2.2 Application note

▪ 2.3 trigger events

▪ 2.4 Refined MIMs

▪ 2.5 Hierarchy message descriptions

▪ 2.6 Interactions

A question was asked regarding the receiving system if we had considered/included the need for acknowledging the receipt of the document. Example was given of a duplicate message sent regarding the same document without any change from what the receiving system already possessed. The belief is that this is addressed within the Medical Record chapter through the document states and the 4 transition states.

Keith suggested the state transition diagram from medical records needed to be added to the CDA. Calvin reminded the committees that this had previously been discussed at length and the decision was not to include it in the CDA.

Bob asked Bill Braithwaite if we needed to fold in additional requirements from the NLM project. Bill states participants would like a clear demarcation between the messaging and the transport mechanism. This is because some will be using EB XML or another transport service.

Bob feels that Rene Spronk’s proposal (see attachment) is a good start to developing the first query message.

[pic]

Current needs to go to normative ballot:

1. Time does not allow us to go to ballot in November. The request for ballot has to be submitted by October 17, 2005.

2. Update the current model against the:

a. Current RIM

b. Current CDA – so they are the same language and consistent

3. Query messages need to be added. Use the summary list John Travis put together from his call for use cases.

4. Review the IHE ITI/XDS technical framework – release 2 for the query work that has already been done and is currently being used.

5. Review Rene’s proposal

6. Bob will F/U with Bill Braithwaite about the HL7 NLM project requirements.

Time line for going to ballot:

▪ Have updated DSTU ready to present to the committee at the January 2006 WGM for committee approval for ballot and

▪ Submit the request for ballot

▪ Go to ballot in March 2006.

Action items:

▪ Bob will reconcile with CDA

▪ Review other chapters to see how they have handled query messages – probably a separate topic.

▪ Co-chairs of MR/IM will be responsible for monitoring the ballot timeline and keeping the committee and work on track.

▪ Co-chairs will facilitate use case development to elaborate on example use cases for the query message structure Bob proposes

▪ Bob will update the Medical Records model, after which co-chairs will facilitate a review of the parameters that should be included in the query message.

Keith suggests Bob do a presentation of V3 modeling presentation in January. Bob will complete work and send it out on the list serve for committee members to review prior to the January 2006 meeting.

A joint meeting will be scheduled for the January 2006 WGM for Tuesday Q1 & Q2 joint meeting.

Quarter 2:

▪ V2.6 ballot reconciliation was done. All but two were publishing, formatting corrections that were done.

Quarter 3:

▪ V2.6 ballot reconciliation was completed. Two reference corrections were reviewed and the changes were made per the balloter’s suggestions.

▪ Reviewed the uses case scenarios submitted to the committed via e-mail. See attached summary document.

[pic]

Quarter 4:

▪ Based on his summarization of the sample query by parameter examples he received, John has begun an excel spreadsheet with the TXA elements across the top. The committee began drafting use cases by describing query scenarios and then listing the required parameters.

▪ Work on query use cases continued. See attached workbook for details.

[pic]

▪ Matt will continue to work on building uses cases between meetings.

▪ Michelle asked the question – is there work for this committee to define the “legal health record”? After discussion there doesn’t seem, at least at this time, to be a place for this topic.

Wednesday, September 14, 2005

Quarter 1 – Quarter 3:

▪ Time was spent reviewing and updating the 9.9.1 Medicolegal agreements short description section of V2.X. Refer to the document for details.

▪ [pic]

Quarter 4:

Garry Cruickshank from the Canadian Health Infoway Canadian Electronic Drug Messaging (CeRx) project requested to meet with the committee to discuss Consents and key words. Garry began by giving the committee a brief presentation on health care in Canada and this new project. Healthcare in Canada is publicly funded and under provincial jurisdiction, although the federal government tries to influence through its financial contributions. The Canada Health Act does guarantee some consistency across the country. Canada has a law known as PIPEDA (Personal Information Protection and Electronic Documents Act), which is broader than the U.S. HIPAA legislation. Gary is involved with an e-prescribing and electronic health records portion of the Infoway project. The project will need all sorts of messaging including e-prescribing and consent messages.

The consent-messaging piece revolves around the patient’s right to “mask” their information. Masking data is a methodology that would allow the patient to “hide” their data at different levels. Examples are: a diagnosis, which would include all associated prescriptions, dispenses, a particular prescription, which would include all dispenses, a medication list, etc.

Currently most of the required messages are in the pharmacy chapter but additional message requests have also been taken to the Patient Care TC (medical conditions, basic observations, professional services, adverse drug reactions and allergies). They have two messages for consents they would like to have developed and brought to ballot during the V3 ballot of the Medical Records chapter. The group is willing to assist the committee with advancing the work for this initiative.

Garry shared a brief PowerPoint presentation to further explain the need and the work on the messages that has already been done. (Insert the PowerPoint)

Next Garry shared the concept of “Keywords” that is a part of the legislation and the project. Keywords is a technique that one jurisdiction in Canada has set-up to implement the masking requirement. The key word is supplied by the patient and must be given each time a service is required.

The other option allows sending that consent has been provided. The messages also allow for emergency access by healthcare providers.

The entire Canadian system is a request system that allows for accept, reject, overwriting.

Given that Medical Records does not plan to ballot normative materials until the spring ballot, Garry suggested that the Canadian messages be presented in the next ballot under Medical records ‘for information only’, clearly being noted as ‘Canadian’ versions. This occurred with the last ballot cycle with material in Patient Care and was well received. The Canadian team would then work with Medical Records to prepare the material for normative ballot the next cycle. The committee agreed this was acceptable. Garry suggested he could arrange to have their current material posted for review and discussion in its Canadian view and it might be discussed at teleconferences if need be,

We’ve invited Gary or a representative to attend the January meeting on Tuesday Q2.

Agenda for January 2006 Working Group Meeting:

Tuesday:

Q1 – Joint with structured documents

▪ Presentation of query message(s)

▪ Presentation of proposed V3 ballot material for committee approval

Q2 – Presentation and continued discussion with Canada INFOHIGHWAY project regarding V3 consent messages.

Q3 & Q4 - Complete V2 consent section review.

Wednesday:

Q1 –Q4 - Additional topics to be determined based on between WGM work.

Action items from this meeting:

1. John and Matt are going to work on use case storyboards for the QBP.

2. Bob is working on the currency of the current DSTU against the current RIM and the current CDA.

3. Bob is going to create and propose the message structure for the QBP requirements.

4. Nancy will attempt to determine what the ballot milestones and timeline is.

5. Nancy will complete the administrative meeting work for the next meeting.

6. Nancy will distribute the consent work from this meeting to several list serves (i.e. MR/IM, PA, E.H.R. , Patient Care, International Affiliates, orders and observations) requesting comments, additions, and validate the need in V2 and/or V3.

7. Teleconferences will be scheduled as needed.

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